Continued Surveillance

Although regression of BE is possible after operation, surgery does not alleviate or replace the need for ongoing surveillance of these patients. In our own series, the complete regression of long segment BE (> 3 cm) did not occur, although many patients did have a reduction in total length of disease.

Two factors may be responsible for the superior response of the epithelium to surgical therapy. First, medical therapy titrated to symptom relief usually does not eliminate acid exposure (Dixon et al, 2001). Second, there may be a significant role of alkaline and bile reflux in the pathogenesis of BE progression. Supporting the concept that reflux must be dramatically reduced for regression of BE to occur, we found that regression occurred only when surgical therapy effectively reduced all types of reflux. Thus, antireflux surgery controls symptoms, allows for the discontinuation of medicine, and gives the patient the best chance at regression of the disease. Therefore, laparoscopic antireflux surgery is an excellent option that should be considered and offered to most patients with BE.

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